HomeMy WebLinkAbout125216 WALSH ENVIRONMENTAL - INSURANCE CERTIFICATE (12)eITe..rrr• a��
ACORD� CERTIFICAT BILITY INSURANCE
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PRODUCER - 11
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
HRH of Upstate New York, LLC D
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
344 Delaware Avenue u I
Buffalo, NY 14202 lUL 3 Zp06
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
716 856-1100
INSURERS AFFORDING COVERAGE
NAIC #
INSURED
Walsh Environmental S 1
Engineers, LLC
4888 Pearl E. Circle, Suite 108
Boulder, CO 80301
INSURERA: Commerce 8; Industry Ins. CO.
19410
INSURER B:
INSURER C:
INSURER D:
INSURER E:
L"Ar,
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INV
INSRH
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
(MMIDDNY)
POLICY EXPIRATIONDATE
DATE (MMIDDfYYI
LIMITS
A
GENERAL LIABILITY
GL4178739
08/01/06
08/01/07
EACH OCCURRENCE
$3000000
COMMERCIAL GENERAL LIABILITY
DAMAGE TO RENTEDPRrMISF.C; (Ea
$500 OOO
MED EXP (Any me person)
$50 000
CLAIMS MADE O OCCUR
PERSONAL & ADV INJURY
s3.000.000
GENERAL AGGREGATE
$3 000 000
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMPIOP AGG
s3,000,000
17 POLICY PRO- LOC
A
AUTOMOBILE LIABILITY
X ANY AUTO
CA5053647
08/01/06
08/01/07
COMBINED SINGLE LIMIT
(Ea accident)
$2,000,000
ALL OWNED AUTOS
SCHEDULED AUTOS
BODILY INJURY
(Per person)
$
X HIREDAUTOS
X NON -OWNED AUTOS
BODILY INJURY
(Per accident)
$
PROPERTY DAMAGE
(Per accident)
$
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
$
OTHER THAN EA ACC
$
ANY AUTO
$
AUTOONLY: AGG
A
EXCESS/UMBRELLA LIABILITY
X OCCUR CLAIMS MADE
BE5190387
08/01/06
08/01/07
EACH OCCURRENCE
$10000 000
AGGREGATE
$10 00O 000
S
E
RDEDUCTIBLE
X RETENTION $ 10000
$
WORKERS COMPENSATION AND
WCT SATU- OTH-
TS ER
ER
EMPLOYERS' LIABILITY
E.L. EACH ACCIDENT
$
ANY PROPRIETORIPARTNER/EXECUTIVE
E.L. DISEASE - EA EMPLOYEE
$
OFFICER/MEMBER EXCLUDED?
H yes describe under
SPECIAL PROVISIONS beiow
E.L. DISEASE - POLICY LIMIT
$
OTHER
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
MOLD ASSESSMT 200 MTN(TR)
CITY OF FORT COLLINS
835 WOOD ST
FORT COLLINS, CO 80526
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL An DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
�..� A&•VV "U01 T OT 2 PMJIU24 SMD 0 ACORD CORPORATION 1988
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may
require an endorsement. A statement on this certificate does not confer rights to the certificate
holder in lieu of such endorsement(s).
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between
the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it
affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon.
,cvv uvul Z Oi Z iFM37U24
rHanfil• R49
Cf`f11 C\Il/
ACORD,u CERTIFIC
ITY INSURANCE
DATE(os°"YYY)
rrr
PRODUCER
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
HRH of Upstate New York, LLC ti
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
344 Delaware Avenue i 3 1 1006
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED
i-I
Buffalo, NY 14202
BY THE POLICIES BELOW.
716 856-1100
I 4SURERS AFFORDING COVERAGE
NAIC #
INSURED
SURER A: Commerce 81 Industry/ Ins. CO.
19410
Walsh Environmental Scientists &
Engineers, LLC
INSURER B:
4888 Pearl E. Circle, Suite 108
INSURER C:
Boulder, CO 80301
INSURER D:
INSURER E:
CKe]'/ 4 JACI =1-9
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
LTR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE (M1MFDDr1'Y1
POLICY EXPIRATION
DATE (MMIDDIM
LIMBS
A
GENERAL LIABILITY
GL4178739
08/01/06
08/01/07
EACH OCCURRENCE
$3 QQQ QQO
COMMERCIAL GENERAL LIABILITY
CLAIMS MADE a OCCUR
DAMAGE TO RENTEDPREMISE (E. nancel
$500 000
MED EXP (Any we person)
$50 000
PERSONAL & ADV INJURY
$3 000 000
GENERAL AGGREGATE
$3 000 000
GENT AGGREGATE LIMIT APPLIES PER:
PRODUCTS- COMP/OP AGG
$3 00Q 000
POLICY PRO LOC
A
AUTOMOBILE LIABILITY
X ANY AUTO
CAS053647
08/01/06
08/01/07
COMBINED SINGLE LIMIT
(Ea ardent)
$2 000 000
+ +
ALL OWNED AUTOS
SCHEDULED AUTOS
BODILY INJURY
(Per perms)
$
X HIRED AUTOS
X NON -OWNED AUTOS
BODILY INJURY
(Per accident)
$
PROPERTY DAMAGE
(Per accident)
$
-
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
$
OTHER THAN EA ACC
$
ANY AUTO
$
AUTO ONLY: AGG
A
EXCESSIUMBRELLA LIABILITY
X OCCUR CLAIMS MADE
BE5190387
08/01/06
08/01/07
EACH OCCURRENCE
$10 000 000
AGGREGATE
$10 000 000
$
$
FDEDUCTIBLE
$
X RETENTION $ 10000
WORKERS COMPENSATION AND
TWOSLTATU
IMIT OTH-
EMPLOYERS' LIABILITY
E.L. EACH ACCIDENT
$
ANY PROPRIETOR/PARTNEWEXECUTIVE
E.L. DISEASE - EA EMPLOYEE
$
OFFICERIMEMBER EXCLUDED?
If describe under
SPECIAL PROVISIONS below
E.L. DISEASE - POLICY LIMIT
It
OTHER
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
PARK SHOP MOLD ASSESS(TL)
CITY OF FORT COLLINS
835 WOOD ST
FORT COLLINS, CO 80526
LD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL In DAYS WRITTEN
E TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
iE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
M\ WMW L.l (CUV IIU6) T Of 2 #M37024 SMD ® ACORD CORPORATION 1988
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may
require an endorsement. A statement on this certificate does not confer rights to the certificate
holder in lieu of such endorsement(s).
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between
the issuing insurer(s), authorized representafive or producer, and the certificate holder, nor does it
affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon.
MVWnw Au7 kAVV 1/VOf 2 GT 2 OM37024
Fern GLUV
ACORDTM CERTIFICATE OF LIABILITY
INSURANCE
07/26106D"YYY)
PRODUCER
HRH of Upstate New York, LLC
344 Delaware Avenue
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Buffalo, NY 14202
716 856-1100
INSURERS AFFORDING COVERAGE
NAIC #
INSURED
Walsh Environmental Scientists &
Engineers, LLC
4888 Pearl E. Circle, Suite 108
Boulder, CO 80301
INSURERA: Commerce & Industry Ins. Co.
19410
INSURER B:
INSURERC:
INSURER D:
INSURER E:
COVFRACFS
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
LTR
N R
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE IMWDDIYYI
POLICY EXPIRATION
DATE (MMIDDIM
CHARS
A
GENERAL LIABILITY
GL4178739
08/01/06
08/01/07
EACH OCCURRENCE
$3 000 O00
COMMERCIAL GENERAL LIABILITY
DAMAGE TO RENTED
$500OOO
CLAIMS MADE a OCCUR
MED EXP (Any we person)
$50000
PERSONAL d ADV INJURY
$3 000 000
GENERAL AGGREGATE
s3,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMPIOP AGG
$3 000 000
F_1POLICYF_j PRO- LOC
A
AUTOMOBILE LIABILITY
X ANY AUTO
CA5053647
08/01/06
08/01/07
COMBINED SINGLE LIMIT
(Ea accident)
$2,000,000
BODILY INJURY
(Per person)
$
ALL OWNED AUTOS
SCHEDULED AUTOS
BODILY INJURY
(Per accident)
$
X HIRED AUTOS
X NON -OWNED AUTOS
PROPERTY DAMAGE
(Per accident)
$
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
$
OTHER THAN EA ACC
$
ANY AUTO
$
AUTO ONLY: AGG
A
EXCESSIUMBRELLA LIABILITY
BE5190387
08/01/06
08/01/07
EACH OCCURRENCE
$10 000 000
X I OCCUR CLAIMS MADE
AGGREGATE
$1 O OOO 000
$
DEDUCTIBLE
$
X RETENTION $ 10000
WORKERS COMPENSATION AND
OR STATUS OTH-
Y LIMITS
EMPLOYERS' LIABILITY
ANY PROPRIETORIPARTNERIEXECUTIVE
E.L. EACH ACCIDENT
$
E.L. DISEASE - EA EMPLOYEE
$
OFFICER/MEMBER EXCLUDED?
H describe under
SPECIAL PROVISIONS below
E.L. DISEASE - POLICY LIMIT
$
OTHER
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
SPCC PLAN UTIL DEPT (T7)
CITY OF FORT COLLINS
UTILITIES DEPARTMENT
PO BOX 580
FORT COLLINS, CO 80522-0580
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL -An DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER ITS AGENTS OR
REPRESENTATIVE
ACORD 25 (2001108)1 Of 2 #M37024 SMD ® ACORD CORPORATION 1988
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may
require an endorsement. A statement on this certificate does not confer rights to the certificate
holder in lieu of such endorsement(s).
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between
the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it
affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon.
•+a Wmw &Qv kcvvuuul 2 of 2 SM37024